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Biomedical subjects

S M Selbst

Publications and source records attributed to S M Selbst.

At least 37 records · Page 2Linked to original sources
PubMed1999

Back pain in children who present to the emergency department.

The purpose of this study was to identify the causes and epidemiology of back pain in children who present to the emergency department. All children who presented to an urban pediatric emergency department (ED) during a 1-year period with the chief complaint of back pain were examined and evaluated with a uniform questionnaire. This was completed at the time of the ED visit in 48%, and within 48 hours in 52%. During a 1-year period, 225 children with a complaint of back pain were evaluated. The mean age was 11.9 +/- 4 years and 60% were female. Onset was acute (< or = 2 days) in 59%, and chronic (> or = 4 weeks) in only 11.6%. Pain awakened children from sleep in 47%, and caused 52% to miss school or work. The most common diagnoses were direct trauma (25%), muscle strain (24%), sickle cell crises (13%), idiopathic (13%), urinary tract infection (5%), and viral syndrome (4%). Radiographs of the back were rarely helpful. About 5% required hospital admission; one half of these were attributed to sickle cell crises. We conclude that back pain is an uncommon reason for children to present to an emergency department. When present, pediatric back pain is most often musculoskeletal, associated with an acute infectious illness or a traumatic event. Although the etiology is rarely serious, back pain often affects the daily activities of symptomatic children.

Acute Disease↗
PubMed1998

Saline with benzyl alcohol as intradermal anesthesia for intravenous line placement in children.

BACKGROUND: It has been suggested that saline with benzyl alcohol preservative has anesthetic properties when injected intradermally. We compared the pain associated with intravenous line (i.v.) placement in patients who received intradermal lidocaine, intradermal saline + benzyl alcohol preservative, or no anesthesia. METHODS: We performed a prospective randomized clinical trial in a convenience sample of children over 6.8 years old seen in the emergency department of a large, urban children's hospital. Children received either intradermal saline with 0.9% benzyl alcohol preservative, intradermal lidocaine, or no anesthesia prior to i.v. placement. The patient recorded the pain of the entire procedure on a visual analog scale. In the two groups that received an intradermal injection, the patient also recorded the pain of the first and second injection on a similar scale. RESULTS: Ninety-nine children were studied, 33 in each group. Pain scores were not normally distributed. The median pain scores in millimeters for the entire procedure were 41.0 (interquartile range, 11 to 62) in the nonanesthetic group, 9.0 (interquartile range 3 to 37) in the saline with benzyl alcohol group, and 10.0 (interquartile range, 4 to 32) in the lidocaine group (P = 0.006 for saline vs nonanesthetic, P = 0.04 for lidocaine vs nonanesthetic, P = 0.57 for saline vs lidocaine). There was no difference between groups with regard to baseline anxiety, demographic characteristics, size of i.v. inserted, number of i.v. attempts, or pain upon intradermal injection. CONCLUSION: Saline with benzyl alcohol and 1% lidocaine are equally effective as intradermal anesthetics for i.v. line placement in children, and are both more effective than no anesthesia.

Adolescent↗
PubMed1998

Retropharyngeal abscess after blunt trauma in an adolescent.

Retropharyngeal abscess is an unusual infection in teenagers, and it is rarely associated with blunt trauma. We present the case of 17-year-old male who developed signs and symptoms of retropharyngeal abscess soon after being struck by a car. The case illustrates that retropharyngeal abscess should be considered, even in an adolescent, if the patient has fever, neck stiffness, and sore throat with symptoms out of proportion to the oropharyngeal findings.

Accidents, Traffic↗
PubMed1997

Pediatric nonpowder firearm injuries: outcomes in an urban pediatric setting.

BACKGROUND: Approximately 32 000 nonpowder firearm injuries are reported annually with more than 60% occurring in the pediatric population. Case reports of serious and fatal injuries have been described; however, no large inclusive series have been published. We reviewed an 11-year experience of an urban pediatric emergency department to evaluate the circumstances, spectrum of injuries, and outcomes attributable to nonpowder firearms. METHODS: A retrospective, descriptive case series of all children 18 years of age or younger evaluated at an urban children's hospital from January 1983 through December 1994 were eligible for study. Patients were identified using a computerized database, the National Electronic Injury Surveillance System, and the trauma registry in the department of surgery. Medical records were reviewed to collect demographic information, circumstances of injury, anatomic site and type of injury, treatment, and outcomes for nonpowder firearm injuries. RESULTS: One hundred eighty patients were identified, and a complete data set was available for 166 (92%). The mean age was 12 +/- 3.7 years, 24% of children were <10 years old, and 71% of the children were male. Three patients returned with a second nonpowder firearm injury during the study period. Forty-nine percent of injuries were intentional and 44% of all injuries occurred during the summer and early fall months. The most common sites of injury were the extremity/buttocks (39%), head and neck (33%), thorax (13%), and eye (8%). Serious injuries included intracranial hemorrhage, cardiac right ventricle laceration, hyphema, and abdominal visceral injury (liver laceration, pancreatic laceration, intestinal perforation). The majority of wounds required local wound care, and the children (74%) were discharged from the emergency department. Of the patients admitted to the hospital (27%), 45% required operative intervention. There were no deaths. Seven percent (12/166) of patients sustained some functional deficit with 42% (5/12) the result of an ocular injury. CONCLUSION: The majority of nonpowder firearm injuries are minor; however, the potential for serious injury should not be underestimated. Minor injuries can be treated with local wound care and tetanus prophylaxis, and patients can be discharged from the emergency department. Education of parents and children to the potential risks associated with these weapons is essential. Stricter regulations regarding ownership of nonpowder firearms and mandatory safety instruction should be considered.

Adolescent↗
PubMed1997

Consultation with the specialist. Chest pain in children.

Chest pain is a common complaint among children of all ages. It rarely is due to cardiac disease, but deserves careful evaluation for this possibility, with laboratory tests performed in limited cases. The child who has pain of acute onset that interferes with sleep, is precipitated by exercise, or is associated with dizziness, palpitations, syncope, or shortness of breath should be evaluated with the aid of laboratory tests. This includes at least a chest radiograph and electrocardiogram. Also, pain in the child who has a history of coin ingestion, trauma, previous cardiac disease, or conditions that put him or her at risk for developing cardiac pathology deserve further study. Likewise, those who have a history of conditions such as asthma, Marfan syndrome, or sickle cell disease warrant special consideration. Finally, most of those who have an abnormal physical examination (fever, respiratory distress, abnormal breath sounds, cardiac murmur, abnormal rhythm or heart sounds, palpable subcutaneous air, or obvious trauma) also require a chest radiograph and an electrocardiogram. However, the child who has chronic chest pain normal physical examination with no worrisome history needs reassurance and careful follow-up rather than extensive studies.

Adolescent↗
PubMed1997

Emergency Medical Treatment and Active Labor Act: legal concerns about private or managed care patients in the emergency department.

The Emergency Medical Treatment and Active Labor Act (EMTALA) was passed to prevent hospitals from refusing to care for an indigent patient in an emergency situation or transferring the patient before the emergency medical condition was stabilized. The act applies to all patients, whether or not they have insurance or belong to a managed care organization. At times, managed care organizations conflict with emergency departments on the treatment of children who present for care when life-threatening emergencies are not apparent. These conflicts frequently involve EMTALA with regards to medical screening examinations and transfer of patients from the emergency department to other facilities.

Emergencies↗
PubMed1996

Latex allergy in pediatric emergency department personnel.

Allergy to natural latex proteins has been recently recognized as a dangerous entity among health care professionals. Cutaneous symptoms related to latex glove use vary from the redness and scaling of contact dermatitis to urticaria. In addition, anaphylactic reactions have been reported. We report the spectrum of reactions to latex glove use in 93 members of our emergency department (ED) staff during a one-month study period. In addition, we attempt to correlate these symptoms with serologic evidence of atopy and latex allergy. Eighty-four of these subjects underwent total serum immunoglobulin E and latex-specific radioallergosorbent test (RAST) testing. Fifty-four percent of subjects reported symptoms relating to latex glove use, categorized as either contact dermatitis (48.4%) or urticaria (5.4%). Of the urticaria group, two subjects reported additional symptoms related to latex glove use such as rhinitis, conjunctivitis, or sneezing. All three groups of subjects (asymptomatic, contact dermatitis, and urticaria) were alike with respect to age, sex, and race. The urticaria group reported a higher incidence of environmental allergies (chi 2, P = 0.02). Serum total immunoglobulin E levels and latex-specific RAST results did not differ among the three groups. The one subject with a positive latex-specific RAST reported urticarial and nasoocular symptoms when exposed to latex gloves. Seventeen percent of symptomatic subjects reported decreased use of latex gloves because of these symptoms. It was concluded that many members of our pediatric ED staff exhibit a sensitivity to latex antigens. Clinical symptoms, rather than serologic testing, must be used to identify latex-sensitive individuals in this setting. Recommendations are offered to assist in the identification and management of hospital personnel who exhibit allergy to latex-containing products.

Adult↗